Main Decision Makers Research Articles

Knowledge, Attitude and Practice on Immunization among Migrant Mothers: A Questionnaire Development and Field Application

Background: Migrant mothers’ knowledge, attitude and practice (KAP) are predictors for children’s vaccination status. Mothers are the main decision makers for childhood health. The objective of this study was to develop a reliable and valid questionnaire to assess the immunization KAP of migrant mothers. Methods: A cross-sectional survey was conducted among migrant mothers by using a questionnaire which was developed by all co-authors according to the objective of this study. Internal consistency was assessed by using Cronbach’s α coefficient. The test-retest reliability was assessed by using Spearman’s rank correlation coefficient. The construct validity was determined through the known-group validity technique. Kruskal-Wallis and Mann-Whitney tests were applied to examine the disparities of immunization KAP of migrant mothers with different socialdemographic characteristics. Results: The mean ± standard deviation (SD) of the knowledge score, attitude score and practice score were 7.8 ± 1.4, 7.2 ± 2.2, 6.2 ± 2.3, respectively. Good internal consistency was found for KAP items with Cronbach’s α coefficient of 0.881, 0.755 and 0.783, respectively. The test-retest reliability showed a satisfactory reliability with a Spearman’s rank correlation coefficient value of 0.817. Migrant mothers with ‘fully immunized’ children showed better KAP scores than mothers who did not, suggesting a good construct validity. Mothers’ age, maternal education level, number of children in household, latest continuous living time, and monthly household income per capita were significantly associated with the immunization KAP among migrant mothers. Conclusions: This study showed an optimal reliability and validity of the questionnaire for measuring the KAP on immunization among migrant mothers in Yiwu and therefore this version can be used in future research.

Immunization knowledge and practice among Malaysian parents: a questionnaire development and pilot-testing

BackgroundParents are the main decision makers for their children vaccinations. This fact makes parents’ immunization knowledge and practices as predictor factors for immunization uptake and timeliness. The aim of this pilot study was to develop a reliable and valid instrument in Malaysian language to measure immunization knowledge and practice (KP) of Malaysian parents.MethodsA cross-sectional prospective pilot survey was conducted among 88 Malaysian parents who attended public health facilities that provide vaccinations. Translated immunization KP questionnaires (Bahasa Melayu version) were used. Descriptive statistics were applied, face and content validity were assessed, and internal consistency, test-retest reliability, and construct validity were determined.ResultsThe mean ± standard deviation (SD) of the knowledge scores was 7.36 ± 2.29 and for practice scores was 7.13 ± 2.20. Good internal consistency was found for knowledge and practice items (Cronbach’s alpha = 0.757 and 0.743 respectively); the test-retest reliability value was 0.740 (p = 0.014). A panel of three specialist pharmacists who are experts in this field judged the face and content validity of the final questionnaire. Parents with up-to-date immunized children had significantly better knowledge and practice scores than parents who did not (p < 0.001 and p = 0.001 respectively), suggesting a good construct validity. A significant difference was found in knowledge and practice scores among parents’ age (p = 0.006 and p = 0.029 respectively) and place of living (p = 0.037 and p = 0.043). The parents’ knowledge level was positively associated with their practice toward immunization (Spearman’s rank correlation coefficient 0.310, p = 0.003).ConclusionsThe pilot study concluded that the Bahasa Melayu version of the immunization KP questionnaire has good reliability and validity for measuring the knowledge and practices of Malaysian parents and therefore this version can be used in future research.

A Fuzzy Multi-Objective Linear Programming Model: A Case Study of an LPG Distribution Network

Supply chain management is a subject that has an increasing importance due to the developments in the global markets and technology. In this paper, a fuzzy multi-objective linear programming model is developed for the supply chain of a company dealing with procurement, storage, filling, and distribution of liquefied petroleum gas (LPG) in Turkey. The model intends to determine the quantities of LPG to be procured, stored, filled to cylinders, and transported between the plants and demand centers for six planning periods. In this model, which aims to minimize both total costs (sum of procurement, storage, filling, and transportation costs) and total transportation distances, demand quantities of the main demand centers and decision maker's aspiration levels about objective functions are fuzzy. After comparing the results obtained from the model with those obtained by using different methods, it is concluded that the proposed method can be applied to real world problems practically and it may be used in this type of problems in order to generate an efficient solution.

Knowledge, attitude and perceptions of mothers with children under five years of age about vaccination in Mangalore, India

Objective: Vaccination is a cost-effective intervention to prevent major illnesses that contribute to child mortality in the country. Increase in parental knowledge about vaccination will lead to increase in vaccination rates of children The main aim of our study was to assess the Knowledge (K), attitudes (A) and perceptions (KAP) of mothers with children under five years of age about vaccination. We also compared the KAP data between urban and rural setup. Methodology: This cross sectional descriptive study was conducted on mothers attending the Urban Health Centre (in Mangalore city) and on mothers attending a Peripheral Health Centre (Bengre, outskirts of Mangalore) having children under five years of age. A semi structured pre validated questionnaire designed to assess the Knowledge, Attitudes and Perceptions about vaccination was administered to mothers attending the Urban Health Centre and on mothers attending a Peripheral Health Centre having children under five years of age. Results: Among the study participants, 74 were from urban setup and 126 from rural set up. Around 8 (10.8%) from urban area and 78(61.9%) from rural area were illiterate. Mothers were the main decision makers regarding vaccination of the child in both urban and rural setup. The main source of information regarding vaccination differed among urban and rural setup, being the hospital and the anganwadi worker respectively. There was a statistically significant difference between urban and rural mothers when it was asked whether they knew why vaccination was important. A majority of the mothers both in the urban and rural areas believed that vaccines were safe. Among the urban mothers 90.5% and 62.7% of mother from rural were able to identify polio as a vaccine preventable disease. On a net analysis, 64(86.5%) mothers in the urban area and only 64 (50.8%) mothers in the rural area mothers found to have favourable knowledge, attitudes, perceptions and practices towards vaccination. Conclusion: A significant number of mothers in rural areas were unaware about the vaccination and its implications. Even in the urban areas we found significant lacunae in the KAP of mothers towards childhood vaccination. DOI: http://dx.doi.org/10.3126/ajms.v5i4.10306 Asian Journal of Medical Sciences 2014 Vol.5(4); 52-57

Five typical city branding mistakes: Why cities tend to fail in implementation of rebranding strategies

City branding has become a widespread phenomenon throughout the world and relevant agencies such as municipalities, local government, media and commercial firms spend large sums of money and vast efforts in order to brand or rebrand cities. Despite these efforts, it appears that many city branding campaigns have not met their objectives. This conclusion resulted from studies of the branding/rebranding campaigns in ten Israeli and several US and European cities. Residents of these cities were questioned about their opinions of the branding campaigns. This was followed by an examination of the branding processes that were undertaken by the sampled city management. Protocols of meetings held to plan the campaigns were examined, followed by in-depth interviews of main decision makers. Five categories of mistakes were identified and analysed. As a result, suggestions are made as to how to avoid such mistakes in the future.

To Ally or Not to Ally with Firms Having Lower Environmental Reputations

Strategic alliance partner selection is a complex process, where trade-off decisions on prospective partners’ attributes must be made. This paper uses the context of environmental reputation asymmetry to explore trade-off dynamics, scarcely dealt with in the literature. More specifically, I examine how CEOs (the main decision makers) reason on whether to decide to ally with a lower-reputation partner, and facilitating factors. Through a multiple-case approach, I find that initiating firms to alliances anticipate changes in partner firms’ reputations. The prospective partner’s propensity to improve is introduced as a core construct; it is proposed to significantly affect the focal firm’s trade-off willingness in the alliance formation situation. My data also reveal some determinants and dynamics in contrast with the ‘learning race’ perspective, suggesting that firms underutilize alliances as a means to enhance their environmental performance at lower cost.

Beyond judgment bias: How students’ ethnicity and academic profile consistency influence teachers’ tracking judgments

Research on school tracking has provided evidence that students with immigrant backgrounds are overrepresented in the lower school tracks. As teachers are the main decision makers when it comes to tracking, we investigated whether teachers’ tracking judgments are biased by the immigrant backgrounds of the students and how teachers’ tracking judgments are affected by inconsistencies in students’ academic profiles. Drawing on dual process models of judgment formation, we conducted two experimental studies to investigate teachers’ judgments. The results of both studies showed less favorable teacher judgments of students with immigrant backgrounds than of students without immigrant backgrounds. Students with inconsistent academic profiles were also judged less favorably than students with consistent profiles. Think aloud data indicated careful processing of all information both for students with immigrant backgrounds and students with inconsistent profiles. Results are discussed with regard to their underlying mechanisms as well as with regard to their implications for teacher training.

G38 Parental Decision-Making at the End of Life in Children Dying of Cancer

BackgroundWhen a child with cancer no longer has a realistic chance of cure, the parents are faced with a range of decisions regarding further treatment options, place of care and...

Lessons learned from the lifecycle management of collaborative enterprises networks

PurposeResearch on the dynamics of Collaborative Enterprises Networks (CEN) lacks consistency and industrial feedback. The purpose of this paper is to present insights and lessons learned from an industrial case study dealing with the practical experience gathered during the creation, alliance development, and business operation phases of a CEN.Design/methodology/approachThe proposed research methodology relies on qualitative approach, using unstructured interviews with the main decision makers in the network. The objective of the interviews is to highlight the most important events in the lifecycle of the network. From the important elements discussed, success and failure key factors are identified.FindingsThrough the case study, the authors identify the main success and failure key factors to consider in CENs. Furthermore, relying on the current state of the art, they highlight the main research directions, particularly with respect to the development of modelling approaches capturing the dynamics of these systems.Originality/valueThe identification of the success and failure key factors and their corresponding technologies, systems and human perspectives is aimed at providing links between theoretical models and practical implications to both academics and industrialists. The challenges and developmental areas proposed provide the basis for new models capturing the dynamics and the evolution of CENs.

Ownership Structure and Earnings Management: Evidence from Iran

Family enterprises have been a major part of capital markets. By possessing most of their stock or being amember of the board, family members are considered the main decision makers in family businesses. Earningson the other hand have always been a performance indicator which is under management control, most oftenmanaged or manipulated.This research seeks to identify and compare earnings management between family andnon-family structured firms. After definingcriteria regarding family and non-family firms, 31 samples wereselected as family based and they were grouped in relevant industries according to Tehran Stock Exchangecategorization. Afterwards we randomly selected non-family firms from those industries with the sameproportion. To test the research hypothesis, Jones adjusted model (Dechow et al, 1995) and multivariableregression model were used. The results indicate a meaningful relation between earnings management andownership structure of firms where in average, non-family firms engagein earnings management more often thanfamily ones.

Psychosocial impact of perinatal loss among Muslim women

BackgroundWomen of reproductive age are vulnerable to psychosocial problems, but these have remained largely unexplored in Muslim women in developing countries. The aim of this study was to explore and describe psychosocial impact and social support following perinatal loss among Muslim women.MethodsA qualitative study was conducted in a specialist centre among Muslim mothers who had experienced perinatal loss. Purposive sampling to achieve maximum variation among Muslims in relation to age, parity and previous perinatal death was used. Data was collected by focus group discussion and in-depth unstructured interview until the saturation point met. Sixteen mothers who had recent perinatal loss of wanted pregnancy, had received antenatal follow up from public or private health clinics, and had delivery in our centre participated for the study. All of them had experienced psychological difficulties including feelings of confusion, emptiness and anxiety over facing another pregnancy.ResultsTwo out of sixteen showed anger and one felt guilt. They reported experiencing a lack of communication and privacy in the hospital during the period of grief. Family members and friends play an important role in providing support. The majority agreed that the decision makers were husbands and families instead of themselves. The respondents felt that repetitive reminder of whatever happened was a test from God improved their sense of self-worth. They appreciated this reminder especially when it came from husband, family or friends closed to them.ConclusionMuslim mothers who had experienced perinatal loss showed some level of adverse psychosocial impact which affected their feelings. Husbands and family members were the main decision makers for Muslim women. Health care providers should provide psychosocial support during antenatal, delivery and postnatal care. On-going support involving husband should be available where needed.

Discharge against medical advice in a pediatric emergency center in the State of Qatar

Objective: The objective of this study was to analyze cases that had left the Pediatric Emergency Center Al Sadd, Doha (PEC) against medical advice, with the aim of developing policies to help reduce this occurrence. Methodology: All patients that were admitted to the main PEC observation room for treatment and/or investigation and subsequently left against medical advice from February 18, 2007 to June 18, 2007, were followed by a phone call, and a questionnaire, which was completed by the departmental patient representative. Results: 99,133 patients attended the facility during the study period. Of those, 106 left the facility against medical advice. Ninety-four guardians were successfully contacted. 90% of the cases were in children below 2 years of age. In 87% of the cases the mother was the main decision maker for leaving against medical advice. Domestic obligations were the leading cause of DAMA (discharge against medical advice), reported in 45% of the cases. Respondents reported that the consequences of DAMA were well explained by medical staff before they left the facility however, they had not met with the departmental patient representative during their stay. Conclusion: As the majority of DAMA cases occurred in infants, medical staff should address the concerns of this group early on in the course of treatment. Maintaining communication and providing support, in particular for mothers of higher risk groups may help to reduce the rate of DAMA cases.

Prevalence of female genital mutilation among female infants in Kano, Northern Nigeria

To determine the prevalence and type of female genital mutilation (FGM) among female infants, reasons and attitude of the mothers to the practice. A cross sectional descriptive study. Tertiary centre in Kano Northern Nigeria. A Pretested questionnaire was administered for mothers of female infants presenting for routine immunization in Aminu Kano Teaching Hospital (AKTH). A total of 250 questionnaires were administered, but only 200 were properly filled and this was used for the analysis. Prevalence and type of FGM, reason for and attitude of mothers towards FGM. Twenty-six infants had FGM during the period of study, giving a prevalence rate of 13 %. The mean age at cutting was 8 days ± 7.3. The commonest type of FGM was type I accounting for 96.2 % of the cases. Tradition/culture was the commonest reason for mutilation accounting for 73.1 %, other reasons included; religious in 11.5 %, hygienic in 11.5 % and to preserve virginity in 3.8 %. Traditional barbers were the commonest operators in 80.8 % of cases, followed by the nurse/midwife in 15.4 % of cases. The fathers were the main decision makers in 46.2 %, followed by both parents in 26.9 % and grandparents in 15.4 % of the cases. 84 % of mothers were not in support of the practice. Thirteen percent of the clients would circumcise all their daughters. Forty-eight percent of the clients were of the opinion that FGM cause harm to the victims. Four percent of those whose daughters were yet to be circumcised will do so later. Female genital cutting is still practiced in our environment. Educational enlightenment is fundamental in changing public opinion as well as in offering reasonable alternative to FGM. Campaign against the practice of FGM should be encouraged to eradicate its practice.

Perceived coercion and need for hospital admission among psychiatric in-patients: figures from a Pakistani tertiary care hospital

In Pakistan, an increasing proportion of psychiatric patients present to community health services as crisis admissions, with their relatives as the main decision makers. Patients are bound to perceive this process as coercive. Farnham & James (2000) report that elements of coercion are found even in voluntary hospital admission, in the form of verbal persuasion, physical force and threats of commitment. Few patients consider hospitalisation justified and most view the process of admission negatively (Swartz et al, 2003; Katsakou & Priebe, 2006; Priebe et al, 2009).

Women, Poverty, and the Epidemic in China: Case Studies on Rural People Living with HIV/AIDS

Based on in-depth interviews with 110 People Living with HIV/AIDS (PLWHA), this qualitative study is a preliminary endeavor to delineate the socio-cultural scripts of rural PLWHA in China including their illness experience, everyday lives, and strategies of coping with stigma, poverty, and social barriers. This study documents the new wave of the “feminization of HIV/AIDS” in China. There is a gender difference of infection routes. Women were infected through heterosexual contact much more frequently than men. This study also discusses power struggles and gender asymmetries between rural couples living with HIV/AIDS, especially on the issues of “disclosure of the illness” and “condom negotiation.” Even when the disease has changed the family structure and women become the main financial supporters, gender inequality within a family is not changed in that women remain not the main decision makers and continue to suffer most from poverty. In conclusion, this article locates women's HIV-related experience within the social ecology of HIV/AIDS, and explores how gender inequality intersects with traditional customs and ethics, economic and political policy, medical system, and patriarchal values to heighten women's vulnerability to both the illness and poverty.

A nonparametric revealed preference test of optimal intra-firm resource allocation

The collective rationality hypothesis initiated by Chiappori (1988a) and applied by Seaton (1997, 2001) for a two-person household is used to distinguish the organizational behaviour of firms. Firms produce satisfaction to groups as traditional managerial and early behavioural theories of the firm of Williamson, Baumol and Marris suggest, as well as more modern principle agent models. Under certain conditions, intra-firm bargaining leads to a Pareto optimal outcome. What makes this work an important contribution is that it identifies a set of nonvacuous testable restrictions to empirically detect if firm-level data satisfy Pareto optimal behaviour for the main decision makers in the organization.

Living with childhood asthma: parental perceptions of risk in the household environment and strategies for coping

AimTo explore parents’ perceptions of environmental household risks to their child’s asthma and to identify the strategies they adopt in relation to these perceived risks.BackgroundThe prevalence of childhood asthma is increasing worldwide and especially in the UK. Asthma is more common in areas of socio-economic disadvantage. Household environmental factors have been implicated in some of this increase. A number of factors in the home environment have been found to act as triggers to asthma symptoms, including high humidity levels, poor ventilation, mould, second-hand tobacco smoke and pet allergens. Little is known about how parents, as the main care-givers and decision makers in the home, perceive and cope with the risks posed by these triggers.MethodsSemi-structured interviews were conducted with a purposive sample of parents of 32 children with asthma aged 4 to 16 years and living in a socio-economically disadvantaged urban community in the North East of England. Interviews were audiotaped, transcribed verbatim and analysed using constant comparison techniques.FindingsAll parents were aware of some of the risks their children faced at home. Some appeared to know more than others and coping styles varied. A typology of three groups of parents was identified: those who actively seek advice and adopt clear preventative strategies (preventers); those who minimize the risks and only react when things go wrong (reactors); and those who engage in compensatory activities in an attempt to trade-off between harms and benefits (compensators). The unifying themes underpinning these different styles are that all parents are motivated to maintain normal family life but that they adopt different strategies to achieve this.

Choosing Where to Have Major Surgery

Efforts are under way to distribute hospital performance data directly to patients to inform their decisions about where to go for major surgery, but patients are not always involved in making the decision of where they will have surgery. Telephone interviews. Five hundred ten randomly selected Medicare patients who had undergone 1 of 5 elective high-risk operations approximately 3 years earlier: abdominal aneurysm repair (n = 103), heart valve replacement surgery (n = 96), or resections for bladder (n = 119), lung (n = 128), or stomach (n = 64) cancer. Main Outcome Measure Proportion of patients who responded that their physician was the main decision maker of where they would have surgery. Thirty-one percent of patients said their physician was the main decision maker about where the patient would have surgery (42% said they decided equally with their physician, 22% said they were the main decision maker, and 5% said their family helped make the decision for them). This proportion was similar across patient age, income, and educational attainment. Men were more likely to say the physician was the main decision maker (34% vs 24%; P = .02), as were patients in poor to fair health compared with those in good to excellent health (37% vs 28%; P = .05). The physician was significantly more likely to be the main decision maker for cardiovascular operations compared with cancer operations (39% vs 26%; P = .001). Although most patients participated in the decision of where they would have major surgery, one third said the decision was made mainly by their physician.

An effective multiple criteria approach to infrastructure reconstruction in devastated countries

Infrastruture facilities in many countries have been repeatedly subjected to natural or human-induced disasters. International aid institutions, such as the United Nations Development Program (UNDP), United States Aid International Development (USAID), Japan International Cooperation Agency (JICA) and the World Bank International Aid Development (IDA), are endeavoring to assist in the reconstruction of devastated countries. Development institutions normally face the problem of selecting and implementing relevant priority infrastructure projects that are needed in various sectors. Usually there are also several key local players in the decision making process. In many cases, these main decision makers have contradictory objectives that lead to conflict and thereby hamper the reconstruction process. In response to this kind of problem, an effective approach has been developed within the field of Multiple Criteria Decision Analysis (MCDA), the Analytical Hierarchy Process (AHP), that can assist decision makers in prioritizing projects to meet specified goals and objectives. Using the AHP approach, the problem of selecting infrastructure projects is dealt with systematically when applying this flexible MCDA technique. This approach takes into account possible uncertainties and social discrepancies, and can use the judgments of the decision makers themselves when there is a lack of technical or historical data. Decision makers from international financial aid institutions, donor agencies, governmental and the local community can utilize this proposed approach.

회복 불가능한 환자의 심폐소새술포기(DNR)와 관련된 윤리문제

The following research has examined ethical dilemmas regarding denial of resuscitation by patients. The articlealso suggests several proposals for optimized solutions. First of all, the history and nature of CPR &amp; DNR have been discussed. Second, mutual interactions during making decisions on DNR have been introduced. Because physicians do not exclusively conduct the decision on DNR, patients, family members, and other related siblings should be involved in the process. If necessary, the ethics committee may be applied for making appropriate decisions. Thirdly, in order to locate the nature of ethical dilemma on DNR decisions, the relationship between patients and physicians, full understanding the importance of CPR necessity, and defining the method of DNR would need to be well explained. Finally, through the ethical discussion on DNR, following conclusions have been suggested. In all situations, DNR must let physicians make decision on futility of CPR for patients' current or future conditions, and the decision must be made only after patients are fully aware of the consequences. Under the law of respecting patients' opinions, patients must have the ability to make decisions on DNR. The proper moments for deciding DNR should depend on behaviors regarding his/her conditions or diseases. Because a health care institution play an important role in making decisions as well, all opinions must be reviewed for the best outcome. It is important to remember that the main decision makers on DNR are patients. Following discussions have concluded that an agreement among people nationwide is quite essential for the appropriate DNR decisions. The research may serve as a supplement for the process of establishing the DNR guideline.